Success in varicocelectomy and its relation to some important clinical and laboratory factors

Varicocelectomy is a common surgical treatment for infertility in men. Due to the fact that infertility treatment is a time-consuming and expensive procedure this study was aimed to determine the factors associated with the successful surgical procedure, in order to make a better prediction of the outcome of treatment. In a cross-sectional descriptive and analytic study, the volunteered patients, whom underwent subinguinal varicocelectomy in Semnan Amiralmomenin hospital between 1387 and 1391, were involved in the study. Patient’s information included age, testicular volume, varicocele grade, sperm quality indicators (motility, morphology, count) and the number of the ligated veins were extracted from the medical records. Success in a period of 4 to 12 months after surgery were evaluated according to improved sperm quality (15% improvement in at least two of the sperm parameters) and the occurrence of pregnancy in married patients were followed up by post-surgery semen analysis and phone contacts. Patients (n=134, 116 married and 18 single) with a mean age of 29.49 (± 6.61) participated in the study. The average volume of the testis was 20.19 ± 1.94 ml and the average number of ligated veins was 4.05 ± 1.15. Patients (25.4%) had grade 1 and 74.6% had grade 2 and 3 varicocele. The average motility, morphology and sperm count before surgery were 33.58 +_16.81, 31.95+_15.65 and 35.25+_33.90, respectively and these indexes after surgery were 39.69+_15.94, 34.76+_14.66 and 46.04+_30.72, respectively. The probability of occurrence of pregnancy as well as improvement in sperm quality in patients was 52.2% and 74%, respectively. The chance for improvement in the quality of sperm was significantly associated with higher degrees of varicocele (P =0.004), lesser the motility (P =0.008) and worse the morphology (P =0.013) of the sperm before surgery. Also the occurrence of pregnancy was significantly associated with the lower age (P =0.003), higher testicular volume (P =0.03) and higher grade of varicocele (P =0.004). This study showed that patients who underwent varicocelectomy, those who were younger, with higher grade of varicocele and testicular volume as well as those who had worse sperm quality before surgery, in terms of motility and morphology, gain more benefit from varicocelectomy